chapter 3. birth choices ◦ drugs during labour and delivery three common drugs: analgesics (pain...
TRANSCRIPT
BIRTH AND EARLY INFANCY
CHAPTER 3
BIRTH CHOICES◦ Drugs during labour and delivery
Three common drugs: analgesics (pain reliever), sedatives (tranquilizers), anesthesia (general, local pain blocker)
All drugs during labour pass through the bloodstream through the placenta
Many women choose to avoid drugs – natural, Lamaze method – prepared childbirth classes
◦ Location of Birth Traditional hospital, hospital-based birthing centre,
freestanding birth centre, at home◦ Presence of Fathers at Delivery
Studies show less pain, less medication, delivered sooner, fewer complications
BIRTH
THE PROCESS OF BIRTH
◦ Stages of Labour Stage 1: dilation and effacement
Not uncommon for women to be 80% effaced and 1 to 3 cm dilated when beginning labour
Lasts 8 to 12 hours for first birth, 7 hours for others Stage 2: delivery of the baby
Begins when woman is encouraged to “push” Cervix is fully dilated Some are breech presentations (feet first or bottom first)
4/5 of these are delivered cesarean Stage 3: delivery of the placenta and other material
◦ Complications Many are possible during birth and are associated
with poor developmental outcomes May not be causal (ie. poverty may cause both birth
AND developmental problems Anoxia – insufficiency of oxygen
Umbilical cord fails to supply blood oxygen (up to 20% of newborns experience some form of anoxia
Dislocated shoulders or hips, fractures, paralysis
◦ Cesarean Deliveries: Also called a c-section
Needed because of breech presentations, fetal distress, labour that does not progress, a fetus that is too large, maternal health concerns
Some numbers of c-section procedures is high About 26% of all births in 2002 (US) One reason is woman are now older – benefits outweigh the
risks In Canada, c-sections covered by public health care plan
debate over whether this should continue ¼ of US c-sections were elective
Spares women from vaginal problems C-section is MAJOR surgery – carries other risks
ie. allergic reactions, infection, injuries, blood loss
◦ Assessing the Newborn Customary to assess immediately at birth and 5
minutes after System used is the Agpar score on 5 criteria:
Heart rate, respiratory rate, muscle tone, response to stimulation to the feet, colour
Another test is the Brazelton scale Tests responses to stimulii – reflexes, muscle tone,
alertness, cuddliness, soothing ability The First Greeting
Intense joy, looking into baby’s eyes, tenderness pattern
LOW BIRTH RATE◦ Optimal weight is between 3 to 5 kg (6.6 to 11
lbs.)◦ LBW – low birth weight – under 2.5 kg (5.5 lbs)◦ VLBW – very low – under 1.5 kg (3.3 lbs)◦ ELBW – extremely low – under 1 kg (2.2 lbs)◦ incidence has declined, but is still high – 7%
below 2.5 kg◦ 19% of these are VLBW
◦ Causes of Low Birth Weight Most common is premature birth (preterm infant)
Multiple births especially likely to end in preterm delivery
Also, mothers with illnesses, serious medical condition more likely to deliver preterm
Mostly unplanned, spontaneous labour, but sometimes elected by physicians using c-section
Small-for-date infant Full 38 weeks, but malnutrition, blood flow constriction,
mother’s smoking
◦ Health Status of Low-birthweight Infants Lower levels of responsiveness early on More than 6 weeks premature -> respiratory distress
syndrome Lungs lack surfactant, an important chemical
◦ Long-term Consequences of LBW Lag behind peers for many years, differences persist Some problems do not appear until school age Some are affected, some develop normally Cumulative effects persist into adulthood Premature infants sometimes given “corrected age”
ie. full term 4 month-old is similar to 1 month premature baby who is 5 months old By school age, this should correct itself, but best assessed case-
by-case
Factors that predict development: Weight, gestational age associated with long-term
developmental delays Neonatal health also important
ie. breathing problems, infectious illnesses, brain injuries Gender
Premature boys more likely than girls Parent responses to the child’s development matters
Degree to which parents’ expectations are realistic Parents’ confidence in their ability to manage challenges
REFLEXES AND BEHAVIOURAL STATES◦ Repetoire of behaviours◦ Reflexes:
Adaptive – sucking, swallowing, end first year of life Rooting – automatic turning of head on touch – nursing Primitive – controlled by the medulla and the midbrain Moro – a primitive reflex involving reaction to loud
noises – throwing arms back, arching back Babinski – splay out toes if foot stroked Linked to later behaviour patterns Walking, tonic neck, grasping Important if baby fails to show reflex
BEHAVIOUR IN EARLY INFANCY
◦ Behavioural States States of consciousness Most infants move through these in the same
sequence: Deep sleep to lighter sleep to fussing and hunger and
then to alert wakefulness Once fed, become drowsy and drop back to sleep Every two hours
Neonates – sleep 90% of time By 6 or 8 weeks it decreases, day/night pattern By 6 months, sleeping 14 hours a day Cultural beliefs also a factor
Some parents conduct cosleeping – sleeping in same bed
Crying: Increases at first, then dropping off after 6 weeks Seen across cultures Also, soothing methods seen across cultures Different cries for pain, anger, hunger Each parent learns the patterns of cries 15 to 20% of infants develop colic
Intense bouts of crying totaling 3 or more hours Awake and alert
2 to 3 hours at beginning, at 6 months, longer periods
◦ Physical and Cognitive Abilities Motor skills
Development proceeds from head downwards (cephalocaudal)
Development occurs from trunk outwards (proximodistal)
Repeated and rhythmic limited movements Sensory and Perceptual Abilities
Newborn can do several things: Focus both eyes on same spot (8-10 inches ideal) Hear sounds, discriminate individual voices, loudness,
pitch Taste sweet, sour, bitter and salty, odours, mother’s smell
◦ Classical Conditioning Newborns can be conditioned, but it is difficult Related to feeding is most successful By 3 or 4 weeks old, no longer difficult
◦ Operant Conditioning Behaviour easily increased by use of reinforcements Neurological basis for learning is present at birth
◦ Schematic Learning (Piaget) Schemas are built up over many exposures to experiences –
development of expectancies◦ Habituation
Reduction in strength or vigor of a response to a repeated stimulus ie. an infant will stop looking at something in front of their face
TEMPERMENT AND SOCIAL SKILLS◦ Temperment
Predispositions that form the foundations of personality
Easy child, difficult child, slow-to-warm-up child Shaped, strengthened, bent by child’s relationships
and experiences ie. difficult child will present troublesome behaviour, but
pattern of criticism and punishment will likely have additional consequences
◦ Emergence of Emotional Expression Some rudimentary expressions are visible at birth
ie. half-smile, responding to smiling face, sadness, anger, surprise
◦ Taking Turns Seen in young infants in eating patterns
Mothers can enter by creating an alternating pattern
◦ Adapting to the Newborn Marital satisfaction typically goes down Less prevelant in planned pregnancies than
unplanned, but virtually all experience it
NUTRITION, HEALTH CARE, AND IMMUNIZATIONS◦ Nutrition: a newborn may eat up to 10 times per
day, then down to 5 or 6, and down to 3 by 8 to 12 months of age Up until 4 to 6 months, babies need only breast milk
or formula and supplements Early introduction to solids may interfere with
nutrition Start with cereals, one new food each week, identify
food allergies
HEALTH AND WELLNESS IN EARLY INFANCY
◦ Health Care and Immunizations Frequent check-ups Vaccinations against a variety of diseases
Publicly-funded in Ontario In 1992, only 55% of US children received full
recommended immunizations Public can become complacent
ILLNESSES◦ Diarrhea – common and deadly (especially in
developing countries Viral or bacterial cause, most common is rotavirus Rehydration the best prevention of death
◦ Upper Respiratory Infections Second most common
◦ Average baby has 7 colds in the first year of life Those in day-cares more than those at home The more people the more colds
◦ Ear Infections Most often leads to a doctor
Follows a cold or allergic reaction Congestion in the eustachian tube
In US, as many as 90% have at least one serious infection before 2
The earlier the 1st infection, more likely for further infections
INFANT MORTALITY◦ Sudden Infant Death Syndrome (SIDS)
Sudden and unexpected death Leading cause of death in US in infants more than 1
month of age Unexplained reasons, rates vary from country to
country High in Australia and New Zealand Low in Sweden and Japan
Higher risk: low birth weight, male babies, African American babies, young mother babies, smoking mothers, babies who sleep on stomach on soft surface
◦ Ethnic Differences in Infant Mortality Differences exist across ethnicities in US Lowest among Asian Americans Natives, Hawaiians, and African Americans high
One reason is natives and african Americans 2 to 3 times more likely to suffer congenital abnormalities and low birth weight
poverty in these groups Mortality rates lower in immigrant groups than US
born mothers Even in college-educated mothers, African American
still more likely to die